RESUMO
OBJECTIVE: To assess the inter-rater agreement of the Royal College of Emergency Medicine (RCEM) Composite Pain Scale. METHODS: A prospective, observational study of 117 children who presented to the ED with pain due to a limb injury. Pain severity was assessed by the triage nurse, doctor and child (depending on their age) using indicators of the RCEM Composite Pain Scale. This pain scale comprises a modified Wong-Baker FACES Pain Rating Scale (FACES Scale), a Behaviour scale and a numerical rating scale (Ladder). Comparisons were made between scores from individual scales and raters. RESULTS: 117 children (26 aged 0-8 years (group 1) and 91 aged >8-16 years (group 2)) were enrolled in the study. Pain in group 1 was assessed by the nurse and doctor using the FACES Scale and the Behaviour scale. The FACES Scale demonstrated greater inter-rater agreement than the Behaviour scale. Pain in group 2 was assessed by the nurse and doctor using the Behaviour scale and by the child using the FACES Scale and Ladder. The Ladder demonstrated poor inter-rater agreement in comparison with the Behaviour Score. CONCLUSION: The Ladder score could be omitted from this composite tool as it has poor inter-rater agreement in comparison with the other indicators.
Assuntos
Medicina de Emergência/métodos , Extremidades/lesões , Medição da Dor/instrumentação , Medição da Dor/métodos , Adolescente , Criança , Pré-Escolar , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Lactente , Masculino , Dor/diagnóstico , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Bilateral paralysis of the facial nerve is a relatively rare presentation and often indicates a serious underlying medical condition. Guillain-Barré syndrome needs to be considered, among others in the differential diagnoses of such presentation. We present here the case of a 35 year old female who presented with bilateral facial nerve paralysis due to the Guillain-Barré syndrome.
RESUMO
Popliteal aneurysms are the most common peripheral arterial aneurysm and occur most commonly among older men with established cardiovascular disease. Popliteal aneurysms are asymptomatic or otherwise present with intermittent claudication, pressure symptoms in the popliteal fossa, distal embolization, and, rarely, rupture. We present a patient with a remarkably large popliteal aneurysm of 10 cm presenting as a popliteal swelling with foot drop and no signs of limb ischemia. According to our literature search, it is the largest reported popliteal aneurysm, and its corresponding symptoms are unusual. The diagnostic workup and treatment are presented.